doctors

The NYT opened up a forum for people to submit ideas on default rules that could be changed. One idea, proposed by a reader in “KC”, that Tina Rosenberg found interesting was around health care appointments.

“When signing up for a health plan, it might be effective to have to opt-out of preventive treatments, such as an annual checkup. I never went for my annual checkup when I was younger because it required researching a doctor and scheduling an appointment. I would have gone to a checkup if I was given a default doctor and had an appointment scheduled for me.”

Choosing a doctor can be a personal choice, which seems like a good reason for resisting switching this default rule for some. But HMO plans have made medicine far more impersonal than it was a generation ago. And with people moving to new cities and need to find new physicians, it might be a default rule switch worth looking into for some patients. The default rule switch need not be some elaborate set up taking into account various preventative procedures. It could be as simple as this: When you sign up for a new health plan, a primary care physician close to your work or home is chosen for you and one appointment is scheduled within the coming few months. You are provided with a number to call to cancel the appointment or to switch doctors.

I found that when it came time to schedule a doctor’s appointment, I’d continuously delay making the call. I’d promise myself to call right after lunch, then in just another hour and before I knew it, the day was over. Fortunately, I’m not the only one with that problem, so here’s the commitment technique I’m using: I made an agreement to share with a friend when I need an appointment, and he shares this with me. Then we just schedule the appointments for each other.

Since I’m not experiencing the uncomfortable doctor’s visit I’m scheduling, I don’t have the urge to try and delay it. With Google Calendar it’s easy to know the other person’s schedule and find a time that works for him. For some reason, making the phone call for an appointment is a bigger barrier to action than sending an e-mail… maybe there’s a lesson in it for doctor’s out there.

Neumannsol links to a New Yorker article by Atul Gawande raising the possible benefits of giving doctors procedural checklists to follow as a way to reduce problems resulting from a bias that dis proportionally weights recent events in the mind (known as the recency bias):

The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.

The checklists provided two main benefits…First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn’t realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.

About

The Nudge blog is the online companion to Richard Thaler and Cass Sunstein’s “Nudge: Improving Decisions About Health, Wealth, and Happiness.” Here you’ll find much more about nudging, choice architecture, libertarian paternalism, and many other terms you won’t read about in standard economics books.

Cass Sunstein is currently the Administrator of the White House Office of Information and Regulatory Affairs and has no affiliation with the Nudge blog.

The Nudge blog is edited by John Balz.

Tell us about a nudge

The possibilities for great nudges are everywhere. For a list of favorites from the book, check out our dozen nudges. We invite readers to send their own nudge suggestions to nudgeblog@gmail.com.

What is Choice Architecture?

Decision makers do not make choices in a vacuum. They make them in an environment where many features, noticed and unnoticed, can influence their decisions. The person who creates that environment is, in our terminology, a choice architect. The goal of Nudge is to show how choice architecture can be used to help nudge people to make better choices (as judged by themselves) without forcing certain outcomes upon anyone, a philosophy we call libertarian paternalism. The tools highlighted are: defaults, expecting error, understanding mappings, giving feedback, structuring complex choices, and creating incentives.

For a user-friendly introduction to choice architecture, check out this paper.